The objective of this study was to systematically review all published articles examining the relationship between the occurrence of falls and changes in gait and attention-demanding task performance whilst dual tasking amongst older adults. An English and French Medline and Cochrane library search ranging from 1997 to 2008 indexed under 'accidental falls', 'aged OR aged, 80 and over', 'dual task', 'dual tasking', 'gait', 'walking', 'fall' and 'falling' was performed. Of 121 selected studies, fifteen met the selection criteria and were included in the final analysis. The fall rate ranged from 11.1% to 50.0% in retrospective studies and from 21.3% to 42.3% in prospective ones. Amongst the three retrospective and eight prospective studies, two and six studies, respectively, showed a significant relationship between changes in gait performance under dual task and history of falls. The predictive value for falling was particularly efficient amongst frail older adults compared with healthy subjects. Two prospective studies challenged the usefulness of the dual-task paradigm as a significant predictor compared to single task performance and three studies even reported that gait changes whilst dual tasking did not predict falls. The pooled odds ratio for falling was 5.3 (95% CI, 3.1-9.1) when subjects had changes in gait or attention-demanding task performance whilst dual tasking. Despite conflicting early reports, changes in performance whilst dual tasking were significantly associated with an increased risk for falling amongst older adults and frail older adults in particular. Description of health status, standardization of test methodology, increase of sample size and longer follow-up intervals will certainly improve the predictive value of dual-task-based fall risk assessment tests.

Gait disorders are more prevalent in dementia than in normal aging and are related to the severity of cognitive decline. Dementia-related gait changes (DRGC) mainly include decrease in walking speed provoked by a decrease in stride length and an increase in support phase. More recently, dual-task related changes in gait were found in Alzheimer's disease (AD) and non-Alzheimer dementia, even at an early stage. An increase in stride-to-stride variability while usual walking and dual-tasking has been shown to be more specifi c and sensitive than any change in mean value in subjects with dementia. Those data show that DRGC are not only associated to motor disorders but also to problem with central processing of information and highlight that dysfunction of temporal and frontal lobe may in part explain gait impairment among demented subjects. Gait assessment, and more particularly dual-task analysis, is therefore crucial in early diagnosis of dementia and/or related syndromes in the elderly. Moreover, dual-task disturbances could be a specifi c marker of falling at a pre-dementia stage.

Background: It has been suggested that high stride-to-stride variability (STV) is a reflection of gait instability. However, both low and high STV has been shown in fallers and in nonfallers; therefore, the interpretation of STV of spatiotemporal gait parameters remains difficult. Thus, we sought to characterize and compare STV of spatial and temporal stride parameters among young and older healthy adults, and to determine the extent to which opposite results in STV could provide similar implications in terms of gait stability. Methods: Mean values of coefficients of variation of spatiotemporal gait parameters were collected from 30 young adults (14 men and 16 women; mean age 28.1 ± 6.0 years) and 33 older adults (2 men and 31 women; mean age 74.4 ± 7.1 years) walking at self-chosen normal walking speed over a GAITRite® System. Results: An age-related increase in STV was only observed with stride width (p = 0.012), whereas increased stride length and stance time variability in older adults were related to decreased walking speed (p = 0.006 and p = 0.018). In addition, both low and high STV was found in both groups of subjects and the highest value was observed for stride width (p < 0.001). Conclusion: The two main implications of the present results are that decreased walking speed should be taken into account when exploring age-related effects on gait variability, and that both low and high spatiotemporal STV may reflect gait stability in healthy adults.

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Besides demonstrating a general overlap in brain regions recruited in young and older participants, this study shows age-related changes in cerebral activation during mental imagery of gait. Our results underscore the importance of executive function (dorsolateral frontal cortex) and spatial navigation or memory function (hippocampus) in gait control in elderly individuals.

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Background: Serotonin has been linked to neuropsychiatric symptoms in Alzheimer disease, mainly agitation/aggression, depression, and psychosis. Neuropsychiatric symptoms have been associated with polymorphisms of the promoter region (5-HTTPR) and intron 2 of the serotonin transporter gene (5-HTTVNTR) or the 5-HT2A and 5-HT2C receptor genes in some but not all studies.Objective: To examine the association of the serotonin promoter, transporter, and receptor genes with neuropyschiatric symptoms in patients with Alzheimer disease. Methods:The sample included 96 patients with Alzheimer disease from the outpatient clinic of the University of California Los Angeles Alzheimer's Disease Research Center, Los Angeles. The Neuropsychiatric Inventory was used to measure neuropsychiatric symptoms, and blood samples were available for genetic analysis. Based on the literature, we hypothesized that the 5-HT2A and 5-HT2C receptor polymorphisms would be associated with agitation/aggression and psychosis and the 5-HTTPR or 5-HTTVNTR polymorphisms, with agitation/aggression or depression and anxiety. One-way analyses of variance were performed with age, ethnicity, sex, or education as covariates.Results: The 102T genotype of the 5-HT2A receptor was significantly associated with delusions (P = .045) and agitation/aggression (P = .002). We did not replicate previous associations of the 5-HT2C receptor polymorphism with psychosis or of the 5-HTTPR polymorphism with agitation/aggression, psychosis, or depression. We did not find any associations with the 5-HTTVNTR polymorphism and agitation/aggression, depression, or anxiety.

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